JIB intestinal bypass description

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This surgery bypassed all but 12-18 inches of the small bowel.  It was developed for quick weight loss and was designed to be reversible when the patient had lost all their weight.  But many patients were intrigued by being able to eat a lot and not gaining as fast as they would have without the bypass so they did not have it reversed.  Although many patients gained back a considerable amount of weight, most hesitated to have them reversed until the years of malabsorption began to cause damage to organs like the kidneys. For those who left the JIB intact, liver failure often resulting in death, was a common long term side effect. An example of an individual with an intact JIB who died from liver failure was Al Hirt, the famous trumpet player.  He had gained a lot of weight back and was over 300 lbs at the time of his death.

In the JIB the stomach was not stapled at all.  There are many patients 30 and 40 years post op who are still around.  Generally after several years, the small bowel enlarges to create more absorption albeit patients still suffer from some vitamin deficiencies due to the rapid passage of food through the digestive tract.

This procedure is MOSTLY not done any more although there are a few surgeons still performing it.  But since patients with more modern surgeries with long limb intestinal bypasses (like the distal gastric bypass and the DS/BPD or BPD) might  face some of the same long term side effects (according to the asbs.org), and for historical reasons, a few accounts are given here.  The JIB was the "gold standard" of Weight Loss Surgery until 1990 when it was replaced by the gastric bypass (invented in 1965) as the "Gold Standard".

According to the ASBMS, the following were the repercussions with the intestinal bypass - some of which, at least, can be expected (they state) in ANY surgery which includes an intestinal bypass even a shorter one (like the gastric bypass):

**** Some modern procedures utilize a lesser degree of malabsorption combined with gastric restriction to induce and maintain weight loss. Any procedure involving malabsorption must be considered at risk to develop at least some of the malabsorptive complications exemplified by JIB. The multiple complications associated with JIB while considerably less severe than those associated with Jejunocolic anastomosis, were sufficiently distressing both to the patient and to the medical attendant to cause the procedure to fall into disrepute.

Listing of jejuno-ileal bypass complications:

Mineral and Electrolyte Imbalance:

* Decreased serum sodium, potassium, magnesium and bicarbonate.
* Decreased sodium chloride
* Osteoporosis and osteomalacia secondary to protein depletion, calcium and vitamin D loss, and acidosis,

Protein Calorie Malnutrition:

* Hair loss, anemia, edema, and vitamin depletion

Cholelithiasis:

Enteric Complications:

* Abdominal distension, irregular diarrhea, increased flatus, pneumatosis intestinalis, colonic pseudo-obstruction, bypass enteropathy, volvulus with mechanical small bowel obstruction.

Extra-intestinal Manifestations:

* Arthritis
* Liver disease, occurs in at least 30%
* Acute liver failure may occur in the postoperative period, and may lead to death acutely following surgery.
* Steatosis, "alcoholic" type hepatitis, cirrhosis, occurs in 5%, progresses to cirrhosis and death in 1-2%
* Erythema Nodosum, non-specific pustular dermatosis
* Weber-Christian Syndrome
* Renal Disease:
* Hyperoxaluria, with oxalate stones or interstitial oxalate deposits, immune complex nephritis, "functional" renal failure.

Miscellaneous:

* Peripheral neuropathy, pericarditis, pleuritis, hemolytic anemia, neutropenia, and thrombocytopenia.

 

http://www.asbs.org/html/story/chapter2.html